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    OpenPayerBilling CodesRepair-Simple Procedures on the Integumentary SystemCPT cpt-12001-simple-superficial-wound-repair-25cm-or-less
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    CPT 12001: Simple repair of superficial wound, ≤2.5 cm

    Medicare pays $118 and commercial payers pay $192 on average nationally for this procedure.

    CPT code 12001 describes the simple repair of superficial lacerations of the scalp, neck, axillae, external genitalia, trunk, and/or extremities (including hands and feet) measuring 2.5 cm or less; service type: simple wound repair; typical site of service: emergency department, urgent care, or outpatient clinic.

    For related coverage guidance, see recent payer policy updates: Mohs Micrographic Surgery, Mohs Micrographic Surgery, Mohs Micrographic Surgery.

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    National Reimbursement Benchmarks

    Medicare's mean reimbursement for CPT 12001 sits at $117.7, which is modestly lower than BUCA's average commercial mean of $192.5. This gap of $74.8 highlights a significant commercial premium versus the federal program, with Medicare concentrated in a narrow middle band (P25 $110 to P75 $123) reflecting relatively stable, locality-driven payments.

    Examining dispersion across payers using the interquartile range (P75 minus P25) shows variation in distribution tightness: Blue Cross Blue Shield has a wide IQR of $104 (P75 $306.1 minus P25 $202.1), indicating substantial variability in commercial contracts, while Aetna's IQR is $86 (P75 $129.9 minus P25 $41.3). UnitedHealth Group's IQR is $83 (P75 $170.5 minus P25 $82.7), Cigna's IQR is $97 (P75 $163.9 minus P25 $68.0), and BUCA's IQR is $93 (P75 $241.2 minus P25 $142.9), placing Blue Cross Blue Shield as the most dispersed and UnitedHealth Group as the tightest among these payers.

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    National Payer Mean Reimbursement Rates

    State Reimbursement Rates

    State: Alaska1 / 51

    Rate by payer

    Clinical & Coding Specifications

    Clinical Context

    A 28-year-old male presents to the emergency department after striking his head on a low beam while moving a ladder. He has a 2.0 cm superficial laceration to the scalp without evidence of a retained foreign body. After triage and wound assessment, local anesthesia is administered, the wound is irrigated, hemostasis is achieved, and a simple layered closure with interrupted sutures is performed. The procedure is documented as a simple repair of a superficial wound of the scalp measuring 2.0 cm, consistent with CPT 12001. The patient is discharged with wound care instructions and scheduled for suture removal in 7 days.

    Related CPT Codes

    CPT CodeDescriptionRelationship to This Procedure
    12002Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 2.6 cm to 7.5 cmUse when the simple wound length falls between 2.6 cm and 7.5 cm instead of 12001

    | 12006 | Simple repair of superficial wounds of scalp, neck, axillae, external genitalia, trunk and/or extremities (including hands and feet); 7.6 cm to 12.5 cm | Use when the simple wound length is between 7.6 cm and 12.5 cm and exceeds the size limit for

    Related Modifiers

    6 rows

    ModifierDescriptionWhen to Use
    25CPT modifier 25 indicates that on the same day as another procedure or service, the same physician or other qualified health care professional provided a significant, separately identifiable…- When to apply: Use modifier 25 only on an E/M code to indicate the same provider delivered a significant, separately identifiable E/M service on the same day as another procedure or service — i.e.,…
    59Modifier 59 indicates a distinct procedural service when two procedures that are not normally billed together are clinically and procedurally separate. The CPT definition (as reiterated by CMS)…- Use modifier -59 to report a distinct procedural service when documentation supports that the procedure reported is not normally billed together with another service on the same day because of a…
    76Modifier -76, Repeat Procedure or Service by Same Physician or Other Qualified Health Care Professional, is appended when the same provider performs an identical, medically necessary procedure or…- Use modifier -76 when the same physician or other qualified health care professional performs an identical procedure or service a second (or subsequent) time on the same date of service and the…
    52Modifier ‑52 (Reduced Services) indicates that a service or procedure was partially reduced or omitted at the provider’s discretion, allowing reporting of the basic procedure number with a qualifier…- Use modifier -52 when a physician or qualified health professional electively reduces or omits part of a procedure or service (for example, performing fewer required views or omitting a portion of…
    53Modifier 53 (Discontinued Procedure) signals that a surgical or diagnostic service was begun by the physician but terminated because of extenuating circumstances that threatened the patient’s…- Use modifier -53 when a physician/qualified healthcare professional has started a surgical or diagnostic procedure (e.g., anesthesia administered, incision or scope insertion) and then discontinues…
    50Modifier –50 (Bilateral Procedure) is appended to a CPT code when an identical procedure is performed on paired anatomical structures during the same operative session. The AMA states to add…- Use modifier -50 when the same CPT surgical, diagnostic, or radiology procedure is performed on paired anatomical structures (both sides of the body) during the same operative/session by the same…

    Related Provider Taxonomies

    8 rows

    Taxonomy Code
    208600000X
    207Q00000X
    207P00000X
    261QR0200X
    207NI0002X
    2279P3800X
    204D00000X
    261QS0132X

    Related Payer Policy Updates

    Specialty: Dermatology1 / 3

    10 rows

    PolicyPayerEffective Date
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    Mohs Micrographic Surgerypremerabluecrossofwashington2027-02-05
    FilsuvezCigna2026-11-01
    Destruction of Pre-Malignant Skin LesionsAnthem2026-10-01
    Onychomycosis diagnostic testing and coverageOscar Health2026-10-01
    Treatment of Capillary Malformations (Port Wine Stains)universityofutahhealthplans2026-09-28
    AnzupgoCigna2026-09-15
    Hyperhidrosispriority_health_medicare2026-09-01
    Zevaskyn Coverage for Recessive Dystrophic Epidermolysis BullosaCigna2026-09-01

    Related Codes

    CPT-12002-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-26-75MM

    CPT 12002: Simple Repair of Superficial Wounds 2.6–7.5 cm

    CPT-12004-SIMPLE-REPAIR-SUPERFICIAL-WOUND-7-6-12-5-CM

    CPT 12004: Simple Repair of Superficial Wounds 7.6–12.5 cm

    CPT-12005-SIMPLE-REPAIR-SUPERFICIAL-WOUND-12-6-TO-20CM

    CPT 12005: Simple Repair of Superficial Wound 12.6–20.0 cm

    CPT-12006-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-20-1-30-CM

    CPT 12006: Simple Repair of Superficial Wound 20.1–30.0 cm

    CPT-12007-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-OVER-30CM

    CPT 12007: Simple repair of superficial wound >30.0 cm

    CPT-12011-SIMPLE-REPAIR-SUPERFICIAL-FACIAL-WOUND-2-5CM-OR-LESS

    CPT 12011: Simple Repair of Superficial Facial/Mucous Membrane Wounds ≤2.5 cm

    CPT-12013-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-2-6-5-0-CM

    CPT 12013: Simple Repair of Superficial Facial Wounds, 2.6–5.0 cm

    CPT-12014-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-5-1-7-5-CM

    CPT 12014: Simple Repair of Superficial Facial Wounds 5.1–7.5 cm

    CPT-12015-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-76-125-CM

    CPT 12015: Simple Repair of Superficial Facial Wounds 7.6–12.5 cm

    CPT-12016-SIMPLE-REPAIR-SUPERFICIAL-WOUNDS-FACE-12-6-20-CM

    CPT 12016: Simple Repair of Superficial Wounds, Face 12.6–20 cm

    Showing 1–10 of 14

    Frequently Asked Questions

    References

    1. 1.CPT® Codes and Descriptions. AAPC. Retrieved Aug 11, 2026.Maintains the CPT code set's official descriptions and guidelines, licensed from the American Medical Association, used as the definitional source for CPT codes on this page.
    2. 2.HCPCS Quarterly Update. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's quarterly release of HCPCS Level II codes and short/long descriptors, the source for HCPCS code definitions and update history.
    3. 3.ICD-10-CM Full Code List. Centers for Medicare & Medicaid Services (CMS). Retrieved Aug 11, 2026.CMS's complete ICD-10-CM diagnosis code list, used to cross-reference diagnosis codes associated with this procedure or service.
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    12001